Meamar Fatemeh Zahra, Savabi-Esfahani Mitra, Farajkhoda Tahmineh
Department of Midwifery and Reproductive Health, Faculty of Nursing and Midwifery, Reproductive Sciences and Sexual Health Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
Department of Midwifery and Reproductive Health, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran.
Int J Reprod Biomed. 2025 Jun 10;23(3):225-240. doi: 10.18502/ijrm.v23i3.18773. eCollection 2024 Apr.
The interpretation of Down syndrome screening results in assisted reproductive technology (ART) pregnancies is challenging. Despite the high psychological burden that false positive results impose on parents, studies that have addressed interpretation of both serum and sonographic markers in both rounds of screening for Down syndrome diagnosis in post-ART pregnancies are limited.
This review study investigated the types of serum screening and imaging for prenatal diagnosis of Down syndrome in ART pregnancies to know and correctly interpret the results of prenatal screenings in these pregnancies.
In this systematic review, an extensive search was conducted in Persian and English in PubMed, Web of Science, Scopus, SID, and Google Scholar without any time limit until January 2024 using appropriate keywords. PRISMA guideline, STROBE, and CONSORT checklists were used.
Review of 30 articles showed in the first screening, pregnancy-associated plasma protein-A was significantly lower than normal values compared to spontaneous pregnancies, while free beta-human chorionic gonadotropin, especially in the in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) was significantly higher. Some studies also indicated an increase in nuchal translucency in the first trimester of pregnancies resulting from ART. Biochemical markers of second screening, in some studies, showed an increase in inhibin-A, a decrease in α-fetoprotein, and unconjugated estriol were evident compared to normal values.
Marker levels may be different for the presence of ovulation-stimulating hormones, multiple corpora lutea, twins or multiplets, type of IVF, and changes in egg cytoplasm in ICSI. Study suggests concentration of maternal serum markers, especially free beta-human chorionic gonadotropin and pregnancy-associated plasma protein-A, should be adjusted differently for each ART (IVF and ICSI separately).
辅助生殖技术（ART）妊娠中唐氏综合征筛查结果的解读具有挑战性。尽管假阳性结果会给父母带来沉重的心理负担，但针对ART后妊娠两轮唐氏综合征诊断中血清和超声标志物解读的研究有限。
本综述研究调查了ART妊娠中用于唐氏综合征产前诊断的血清筛查和成像类型，以便了解并正确解读这些妊娠中产前筛查的结果。
在本系统综述中，于2024年1月前不限时间地在PubMed、科学网、Scopus、SID和谷歌学术中使用适当关键词以波斯语和英语进行了广泛检索。使用了PRISMA指南、STROBE和CONSORT清单。
对30篇文章的综述显示，在首次筛查中，与自然妊娠相比，妊娠相关血浆蛋白-A显著低于正常值，而游离β-人绒毛膜促性腺激素，尤其是在体外受精（IVF）和卵胞浆内单精子注射（ICSI）中显著更高。一些研究还表明，ART导致的妊娠头三个月颈项透明层增加。在一些研究中，第二次筛查的生化标志物显示抑制素-A增加，甲胎蛋白减少，与正常值相比，未结合雌三醇明显减少。
由于促排卵激素的存在、多个黄体、双胞胎或多胞胎、IVF类型以及ICSI中卵细胞质的变化，标志物水平可能有所不同。研究表明，应针对每种ART（分别为IVF和ICSI）对母体血清标志物的浓度，尤其是游离β-人绒毛膜促性腺激素和妊娠相关血浆蛋白-A进行不同的调整。
